Global comparison of awake and asleep mapping procedures in glioma surgery: An international multicenter survey

Abstract Background Mapping techniques are frequently used to preserve neurological function during glioma surgery. There is, however, no consensus regarding the use of many variables of these techniques. Currently, there are almost no objective data available about potential heterogeneity between surgeons and centers. The goal of this survey is therefore to globally identify, evaluate and analyze the local mapping procedures in glioma surgery. Methods The survey was distributed to members of the neurosurgical societies of the Netherlands (Nederlandse Vereniging voor Neurochirurgie—NVVN), Europe (European Association of Neurosurgical Societies—EANS), and the United States (Congress of Neurological Surgeons—CNS) between December 2020 and January 2021 with questions about awake mapping, asleep mapping, assessment of neurological morbidity, and decision making. Results Survey responses were obtained from 212 neurosurgeons from 42 countries. Overall, significant differences were observed for equipment and its settings that are used for both awake and asleep mapping, intraoperative assessment of eloquent areas, the use of surgical adjuncts and monitoring, anesthesia management, assessment of neurological morbidity, and perioperative decision making. Academic practices performed awake and asleep mapping procedures more often and employed a clinical neurophysiologist with telemetric monitoring more frequently. European neurosurgeons differed from US neurosurgeons regarding the modality for cortical/subcortical mapping and awake/asleep mapping, the use of surgical adjuncts, and anesthesia management during awake mapping. Discussion This survey demonstrates the heterogeneity among surgeons and centers with respect to their procedures for awake mapping, asleep mapping, assessing neurological morbidity, and decision making in glioma patients. These data invite further evaluations for key variables that can be optimized and may therefore benefit from consensus.

[1]  M. Berger,et al.  Letter: The European and North American Consortium and Registry for Intraoperative Stimulation Mapping: Framework for a Transatlantic Collaborative Research Initiative. , 2021, Neurosurgery.

[2]  H. Duffau,et al.  Anesthesia management for low-grade glioma awake surgery: a European Low-Grade Glioma Network survey , 2020, Acta Neurochirurgica.

[3]  P. Schucht,et al.  Brain tumors in eloquent areas: A European multicenter survey of intraoperative mapping techniques, intraoperative seizures occurrence, and antiepileptic drug prophylaxis , 2017, Neurosurgical Review.

[4]  M. Tamura,et al.  Intraoperative Functional Mapping and Monitoring during Glioma Surgery , 2014, Neurologia medico-chirurgica.

[5]  Catherine A Schevon,et al.  Extraoperative neurostimulation mapping: Results from an international survey of epilepsy surgery programs , 2014, Epilepsia.

[6]  T. Kayama,et al.  The guidelines for awake craniotomy guidelines committee of the Japan awake surgery conference. , 2012, Neurologia medico-chirurgica.

[7]  V. Seifert,et al.  Intra-operative subcortical electrical stimulation: A comparison of two methods , 2011, Clinical Neurophysiology.

[8]  R. Stendel.  Extent of resection and survival in glioblastoma multiforme: identification of and adjustment for bias. , 2009, Neurosurgery.

[9]  M. Berger,et al.  GLIOMA EXTENT OF RESECTION AND ITS IMPACT ON PATIENT OUTCOME , 2008, Neurosurgery.

[10]  Susan M. Chang,et al.  Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. , 2008, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[11]  Veit Rohde,et al.  EXTENT OF RESECTION AND SURVIVAL IN GLIOBLASTOMA MULTIFORME: IDENTIFICATION OF AND ADJUSTMENT FOR BIAS , 2008, Neurosurgery.

[12]  A. Teramoto,et al.  Intra-operative detection of motor pathways using a simple electrode provides safe brain tumor surgery , 2007, Journal of Clinical Neuroscience.

[13]  V. Seifert,et al.  Intraoperative Risk of Seizures Associated With Transient Direct Cortical Stimulation in Patients With Symptomatic Epilepsy , 2007, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[14]  Martin J. van den Bent,et al.  Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. , 2005, The New England journal of medicine.

[15]  L. D.,et al.  Brain tumors , 2005, Psychiatric Quarterly.

[16]  Yuta Shibamoto,et al.  Influence of extent of surgery and tumor location on treatment outcome of patients with glioblastoma multiforme treated with combined modality approach , 2005, Journal of Neuro-Oncology.

[17]  Susan M. Chang,et al.  Volume of residual disease as a predictor of outcome in adult patients with recurrent supratentorial glioblastomas multiforme who are undergoing chemotherapy. , 2004, Journal of neurosurgery.

[18]  J. Jääskeläinen,et al.  Debulking or biopsy of malignant glioma in elderly people – a randomised study , 2003, Acta Neurochirurgica.

[19]  Z L Gokaslan,et al.  A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. , 2001, Journal of neurosurgery.

[20]  M. Berger,et al.  The effect of extent of resection on time to tumor progression and survival in patients with glioblastoma multiforme of the cerebral hemisphere. , 1999, Surgical neurology.

[21]  G A Ojemann,et al.  Neurophysiological monitoring during astrocytoma surgery. , 1990, Neurosurgery clinics of North America.